Medical Apartheid

Medical Apartheid
Compelling, if at times gruesome, Medical Apartheid connects past medical
experiments and the woeful current state of health care for blacks.

Amaya Rivera
January 05 , 2007

Medical Apartheid: The Dark History of Medical Experimentation on Black
Americans From Colonial Times to the Present
By Harriet A. Washington. Doubleday. $27.95.

In this provocatively titled book, Harriet Washington argues that the
infamous “Tuskegee Experiment”—the 40-year study in which black men with
syphilis were allowed to die untreated so that their cadavers could be used
for research—was not an isolated incident, but rather one example of the
medical establishment’s long history of mistreating African Americans.
Compelling, if at times gruesome, Medical Apartheid draws a connection
between past medical experiments and the woeful current state of health care
for blacks.

Medical Apartheid is peppered with chilling anecdotes of racist
exploitation, curiosity, and control. There is the story of John Brown, a
slave purchased in Georgia in the 1820s, whose owner, a doctor, blistered
his legs and arms on a daily basis to see how deep his black skin went. Far
from merely cataloging horrors, Washington, a journalist and former fellow
in ethics at Harvard Medical School, also illustrates what she calls the
“dual face” of these abuses, pointing out that the exploitation of black
subjects made numerous medical advances possible. For example, Dr. Marion
Sims, a 19th-century gynecological pioneer, was only able to achieve his
breakthroughs by performing horrific surgeries without anesthesia on his
female slaves.

These tales are not limited to the less enlightened past. The forced
sterilization of black women (what civil rights activist Fannie Lou Hamer
plaintively called her “Mississippi appendectomy”) got its start during
slavery, but has persisted in less overt forms in recent years. A 1991
experiment that implanted the now-defunct birth control device Norplant into
African American teenagers in Baltimore was applauded by some observers as a
way to “reduce the underclass.” Washington also finds that racist
assumptions still creep into high-level medical research. A 1992 Columbia
University study looking for a genetic link to violent behavior only
recruited young black boys from poor neighborhoods in New York City.
Researchers misled the parents, claiming their children were simply coming
in for a series of tests and questions, when in fact they were given
potentially risky doses of the same drug found in the Fen-Pfen weight loss
pill.

One of the most harmful contemporary legacies of this history of abusive
medical experimentation is that many African Americans are wary of
participating in potentially life saving medical studies. A recent study in
the American Journal of Law and Medicine estimated that only 1 percent of
the nearly 20 million Americans enrolled in biomedical studies are black.
This reluctance, though justified, has meant that blacks often miss out on
the latest treatments and breakthroughs. In the 1980s, for instance,
virtually no African Americans were used in trials of the HIV inhibitor AZT.
When the drug came into widespread use in 1991, the Food and Drug
Administration had scant research on blacks and erroneously reported that it
was not effective for black patients. If more blacks had been included in
the original studies, Washington wonders, “would the number of HIV-infected
African Americans be lower today?”

Washington’s book is a rallying call for change within the medical and
African American communities. While doctors must understand their black
patients’ fears of exploitation, African Americans, Washington writes,
“cannot afford passivity.” Increased participation in ethically designed
medical studies would not only be a boon to African Americans suffering from
serious diseases but would also lead to better preventive care in general.
As she concludes, “Physicians, patients, and ethicists must…understand that
acknowledging abuse and encouraging African Americans to participate in
medical research are compatible goals.”

FAITH:
When we walk to the edge of all the light we have and take a step into the
darkness of the unknown, we must believe that one of two things will happen.
There will be something solid for us to stand on or we will be taught to
fly. (Patrick Overton).